SimQuest LLC proposes to develop a physics-based vascular surgery skills training simulator that will overcome current shortcomings in experiential open vascular surgery training. This dovetails with the mission of the NHLBI to promote application of research results and leverage resources to address public health needs, in this case, patient safety. When the simulator is complete, users will be able to practice vascular anastomosis until they are shown to be proficient. They will stand as they would at an operating table, view a stereo display of patient anatomy, which they manipulate using actual surgical tools, and encounter the same resistance of skin and vessels during the procedure that they would in real life - effects made possible by advanced, biofidelic tissue and suture material properties and low-cost haptics technology developed by SimQuest with federal funding. The first objective of this Phase II project is to continue to establish a framework and process for surgical, academic, and learning sciences' support for this end-user-driven simulation development and for its validation. This will include continued networking with leaders in vascular surgery education and certification; having learning scientists and experienced surgical trainers dictate, review and validate the goals, metrics, and didactic content; involvement of these experts throughout the iterative design process; and benchmarking and validation of concept. The second objective is to create the virtual reality simulator, which includes the technical components required to simulate the procedure; integrate the metrics; make it possible for users to make and recover from errors in surgical handling of vessels and suture anastomosis; and build, test, and refine the prototype. The final objective will be to validate the curriculum/simulator prototype using state-of-the-science validation methodologies directed by an authoritative academic resource. The proposed project will encompass the necessary research to provide training for all open vascular procedures on an open-source platform and will provide the exemplar procedure of end-to-end anastomosis. This will potentially make it clinically useful to licensing and accreditation bodies. Letters of support from the leadership of all the US national societies involved in vascular surgery training, education, and certification are a testament to the importance of this project to surgical skill acquisition, documentation of proficiency, certification, and patient safety.